beyond the edge

So I'm reading up a bit about gout and the different mechanisms by which colchicine and allopurinol treat gout (yes, yes, I know I have no more exams and it's a wonder I don't know these things but somehow managed to pass anyway).

Allopurinol is easy enough to understand, but when I got to colchicine, it said this, "At micromolar concentrations, it suppresses monosodium urate crystal-induced NACHT-LRR-PYD-containing protein-3 (NALP3) inflammasome-driven caspase-1 activation"

I think my brain died somewhere after the word "crystal".



*Goes to sleep*


BTW Japanese film festival tickets go up tomorrow. I'm gonna order early in case Gantz sells out, so lemme know, people!

From all these ridiculous articles I cannot resist clicking on.

Depression? Don't believe it

Literally that is its title.

And it starts out with...

In 2000 the World Health Organisation named depression as the fourth leading contributor to the global burden of disease and predicted that by 2020 it would rise to second place. I suppose WHO didn’t mean it to sound like a target to be aimed for, but we seem to be rising to the challenge in any case.

Hey, I agree that depression can be over-diagnosed - but it is also under-diagnosed. I agree that people can be overly medicated for depressed mood (as opposed to actual depression). I agree that there is evidence that psychotherapy and CBT works.

But if the nutcase who wrote the article actually spent some time sitting in a psychiatric ward with some patients instead of reading the DSM from beginning to end and scoffing at it non-stop (and by-the-by, I agree that some of the disorders listed in the DSM borders on defining everyone as abnormal), maybe she'll see that you can never use blanket terms in medicine, and that SSRIs are used because they actually work, not because the "Big Pharma" made up the data.

I remember a lady suffering from terrible anxiety disorder, sitting in her chair quivering non-stop like she had too much caffeine. A week later, after a few ECT sessions, the change was remarkable. She managed to smile. She was sitting at ease. She could hold a conversation looking at us in the eye.

Sit in a room with a severely depressed patient whose countenance never cracks, who stares listlessly at the ground and barely raises the energy to whisper answers to questions...and tell me that their depression is imagined.

Overdiagnosis and overtreatment is a problem with any medical condition, but it is a danger to present the argument without a balanced view, especially with mental health still being a relative taboo in our society.

You know that horrible feeling you get where you're perpetually stepping forward but contrary to logic the world around you isn't moving and you're just plunkering on in the same spot and you're getting exhausted but when you stop you realise you're still at the same place?

...Or maybe like Sisyphus but instead the summit is still a distant sparkle and you can't stop lest the boulder starts rolling backwards and crush you on its descent. Or something like that.

Anyway, aside from the boulder of impending doom looming constantly like an ominous and vaguely stalkerish storm cloud, I've actually really enjoyed my med terms, which is a vast improvement on last year. Vascular surgery was always so long but there were quite a few interesting cases I had only heard theoretically about but never watched, like open carotid endarterectomy and AAA stenting and varicose veins stripping (really creepy the first time LOL)

Infectious diseases is also really interesting. I've always loved microbiology, and ID is turning out to be a remarkably diverse learning experience. The range of conditions and the complexity of the patients are amazing, and I think I also like the aspect of meeting with very challenging cases but being able to focus on just one aspect of their overall health and manage it. It's probably one of the few medical specialties that focus on getting patients better or cured in a short space of time (unless you're talking about recurrent or chronic infections, then you're in for the long haul). I'm also picking up a lot of antibiotic names, and I can finally differentiate (some) fluroquinolones from (some) aminoglycosides, for example >_>;

A month ago while I was making cake I accidentally caught my finger in a drawer. I was so busy doing the C & E of the R.I.C.E. in order to stop the blood from dripping all over my hand that before I knew what happened my aunt slapped a slob of fresh ash (from burned paper) on the wound. Apparently there is a theory in Chinese medicine - "blood stops when it meets black".

It worked a treat: as I mentioned before the blood was oozing bad enough to trail down my hand, but after the ash went on, even after several hours there was only a small spot of blood on the bandaid I put over it. But then I completely freaked out when, after washing the finger, I realised the ash was not coming off and was completely adherent to the wound ||||||||Orz

Another time I might have taken my aunt's word that it would come off in time, but I had the misfortunate experience of accidentally pricking myself with a pacer 20 years ago and to this day the (graphite) lead that broke off under my skin is still there as an off-colour "mole". It didn't help that no amount of scrubbing or soap would make the pitch black patch even budge. And that the black patch covered half the surface area of all the visible skin between my D.I.P. joint and my nail Orz

Anyway, to cut the long woeful tale short, the whole thing eventually vanished one day, just before the wound itself actually scarred over. Nevertheless, not an experiment I wish repeated unless on a much less visible area ==; It was surprisingly effective actually, because with the ash covering the wound was completely dry, but if I picked the ash off then it would immediately start oozing.

We had a meeting of The Big Bosses today. It's one of those sessions when you realise, in a pinch, who really makes an effort to understand the students whose interests they supposedly foster and represent. My fondness for a number of supervisors has just increased that much more *___* Thank you for acknolwedging people have - and have the right to have - lives and livelihoods outside med.

Can you skip class today?

Observe the conflict between "We're not talking about an 8am class here, are we?" and "Are you trying to become a doctor? I don't want you to accidentally kill me some day because you skipped this class."

Whoever wrote it obviously has no idea that 8am starts are not just the norm...but practically a luxury if you live on campus. LOL.

Now I am tempted to skip the 8am ward rounds tomorrow...lalala........

Wah wah I'm a medical student

I began reading it expecting I would agree, except I cannot.

Yes sure, I've done my share of whining about unreasonable doctors, but hey, everyone's allowed a bitch, right?

I just think if you're a medical student you have to come to terms with the fact that you chose this profession, with all its self-indulgent and obsessive-compulsive personalities, and no wonder you're going to get chewed to bits while they can grind you into the ground.

And frankly, in any profession with a mix of competitive personalities like that and under that amount of daily stress, you'd get treated like dirt at the bottom of the food chain.

I don't understand the medical student/intern whinge about paperwork. Every profession starts at the bottom of the chain doing the most mundane and nasty of jobs, and works up. I don't see why the medical profession thinks it could be exempt from this.

Yes, 40 years ago people graduated and actually GOT TO DO STUFF, like MEDICAL STUFF. But instead of complaining about the people who are just as locked into the system as you will be, why not hassle the beaurocrats and THE BLOODY LAWYERS who turned the health system this way? After all, it's because of the fear of people in black suits that they've introduced enough paperwork to continually deplete an entire forest (seriously...stuff like sending a copy of every pathology result and discharge letter both by post and by fax just gets the shizz on my inner Greenie, all because of that one patient out of whatever-thousand for whom you might miss the results and end up with a court case on your hands. LIFE WOULD BE BETTER WITHOUT BLOODY LAWYERS. The end.)

So umm...somehow, I think I passed my exams? LOL

Maybe it's the wonders of scaling, because this year's med and surgical exams were pretty full on. Almost no one walked out early in surgical (compared to only 15 people still in their seats after psych, and only because they were too lazy to move XDDD) I actually thought the surgical slightly easier than the med because although the questions were hard (eg. you had to know your contraindications and indications for each procedure, or likely symptoms and signs for each disease - and as always, they never give you enough information), if you took your time and worked through it logically you could narrow it down, whereas med was direct recall of some minor detail receptor pathway that surely you'd never need to ever remember again unless you work in pharmacology ==;;;;;;;;;;

Psych was evil. I never knew you were allowed to test history in a med school exam LOL. Cartesian dualism...basis of moral management...etc Orz Little wonder people walked out early since there's no point sitting there double-guessing yourself.

But I should really stop this bad habit of starting to study for a major exam one week before it |||||Orz

But my mid-term memory is weeaally baaad =( I function better on short-term memory LOL

It makes me feel bad that other people started studying 4 months ago Orz

Well, the next term starts Monday. At least this one doesn't have an exam at the end, but it does, apparently, have 20394 assignments. Back to the grind again....

Passing a long case with "a complex thought disordered patient" = WIN
Forgetting to get signed off as "satisfactory" on the assessment form = FAIL

*Headwall*

Hope he's in tomorrow. LOL.

Spent the last 4 days doing nothing but cram (and also drooling over that Windows phone 7....drooool....I really need a phoneeeee) so I'm really over it, even though I know I still haven't remembered everything about detoxing benzos/alcohol/opioids/marijuana/smoking......etc.

Speaking of Windows phone, apparently this is the fictional target audience: "a 38 year-old couple named Anna and Miles...who need to get work done on their phones but still want to play games and don't want to fiddle around with settings".

......I'm 24 going on 38 =v= I am so falling in that target group. LOL.

Incidentally I think the first omens(LOL) of my intense dislike of Apple came from its original marketing campaign for iPods, putting them as "THE hip thing to have if you're gen X and Y". The cliche is if you call yourself hip you're clearly not hip, and at the time the iPod is seriously...not hip. It was a BRICK compared to the other MP3s available on the market (iRiver and Sony all did some really gorgeous ones), but people are sheep and the fad started and Apple got rich and then the devices actually pulled ahead of its competitors.

It is elsewhere seen in the Twitlight Phenomenon...not that Twitlight is going to pull ahead of anything any time soon, except maybe snagging all the Razzie awards.